Experts: challenges remain for 'brain dead' teen

Wednesday, January 8, 2014

SAN FRANCISCO (AP) — The family of a 13-year-old California girl who was declared brain dead after suffering complications from sleep apnea surgery has achieved its goal of moving the girl to a new facility for long-term care, but medical experts say the ventilator she's on will not work indefinitely.

Jahi McMath's uncle said Monday that she is now being cared for at a facility that shares their belief that she still is alive.

While the move ends what had been a very public and tense fight with the hospital, it also brings new challenges: caring for a patient whom three doctors have said is legally dead because, unlike someone in a coma, there is no blood flow or electrical activity in either her cerebrum or the brain stem that controls breathing.

The bodies of brain dead patients kept on ventilators gradually deteriorate, eventually causing blood pressure to plummet and the heart to stop, said Dr. Paul Vespa, director of neurocritical care at the University of California, Los Angeles, who has no role in McMath's care. The process usually takes only days but can sometimes continue for months, medical experts say.

"The bodies are really in an artificial state. It requires a great deal of manipulation in order to keep the circulation going," Vespa said.

Brain-dead people may look like they're sleeping, he added, but it's "an illusion based on advanced medical techniques."

The family and their lawyer would not disclose where the eighth grader was taken on Sunday night after a weekslong battle to prevent Children's Hospital Oakland from removing her from the breathing machine that has kept her heart beating for 28 days.

The uncle, Omari Sealey, told reporters Monday that Jahi traveled by ground and that there were no complications in the transfer, suggesting she may still be in California. Nurses and doctors are working to stabilize her with intravenous antibiotics, minerals and supplements while she remains on the ventilator, but her condition is too precarious for additional measures, lawyer Christopher Dolan said.

The new facility has "been very welcoming with open arms. They have beliefs just like ours," Sealey said. "They believe as we do ... It's a place where she is going to get the treatment she deserves."

The nearly $50,000 in private donations the family has raised since taking the case public helped cover the carefully choreographed handoff to the critical care team and transportation to the new location, Sealey said. The facility, where Jahi is expected to remain for some time, is run by a charitable organization that so far hasn't sought payment, Dolan said.

Both men refused to name the facility or reveal where it was located, saying they wanted to prevent staff members and the families of other patients from being harassed.

Jahi underwent surgery at Children's Hospital on Dec. 9 to treat severe sleep apnea, a condition where the sufferer's breathing stops or becomes labored while sleeping. Surgeons removed her tonsils and other parts of her nose and throat to widen the air passages.

While recovering in the Intensive Care Unit, she bled heavily from her mouth and nose and eventually went into cardiac arrest. Doctors at the hospital declared her brain dead three days later and moved Dec. 20 to remove her from the ventilator.

Her mother, Nailah Winkfield, refusing to believe her daughter was dead as long as her heart was beating, went to court to stop the machine from being disconnected and twice won injunctions prohibiting the hospital from acting. On Friday, the two sides reached an agreement allowing Jahi to be transferred if Winkfield assumed responsibility for further complications.

An Alameda Superior Court judge who had granted the injunctions refused, however, to force Children's Hospital to fit Jahi with the breathing and feeding tubes that Dolan said are necessary to get her placed in a long-term care facility. Under the judge's order, the hospital released Jahi directly to the coroner, who then released her into the custody of Winkfield.

A federal judge cancelled a hearing on the case scheduled for Jan. 7 after the family and the hospital reached an agreement to transfer Jahi, saying the request for the hearing was now moot.

Sealey, the girl's uncle, said Monday that his sister is relieved her persistence paid off and "sounds happier." He criticized Children's Hospital for repeatedly telling Winkfield they did not need her permission to remove Jahi from the ventilator because the girl was dead.

"If her heart stops beating while she is on the respirator, we can accept that because it means she is done fighting," he said. "We couldn't accept them pulling the plug on her early."

Dolan, the family's lawyer, said Jahi's condition suffered because the hospital refused to feed her once she was declared brain dead. The family plans to pursue a federal court lawsuit alleging that Children's Hospital violated their religious and privacy rights. Winkfield has described herself as a devout Christian. A hearing in the case is scheduled for Tuesday, although the hospital has moved to have it canceled on the grounds that it has become moot with the move.

"She's in very bad shape," he said. "You would be too, if you hadn't had nutrition in 26 days and were a sick little girl to begin with."